Performance of three minimally invasive cardiac output monitoring systems

We evaluated cardiac output (CO) using three new methods - the auto-calibrated FloTrac-Vigileo (CO(ed)), the non-calibrated Modelflow (CO(mf) ) pulse contour method and the ultra-sound HemoSonic system (CO(hs)) - with thermodilution (CO(td)) as the reference. In 13 postoperative cardiac surgical patients, 104 paired CO values were assessed before, during and after four interventions: (i) an increase of tidal volume by 50%; (ii) a 10 cm H(2)O increase in positive end-expiratory pressure; (iii) passive leg raising and (iv) head up position. With the pooled data the difference (bias (2SD)) between CO(ed) and CO(td), CO(mf) and CO(td) and CO(hs) and CO(td) was 0.33 (0.90), 0.30 (0.69) and -0.41 (1.11) l.min(-1), respectively. Thus, Modelflow had the lowest mean squared error, suggesting that it had the best performance. CO(ed) significantly overestimates changes in cardiac output while CO(mf) and CO(hs) values are not significantly different from those of CO(td). Directional changes in cardiac output by thermodilution were detected with a high score by all three methods.